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Microsleep

micro sleep, microsleeps last between __ seconds
A micro-sleep MS is a temporary episode of sleep or drowsiness which may last for a fraction of a second or up to 30 seconds 4-5 seconds according to AAAcom where an individual fails to respond to some arbitrary sensory input and becomes unconscious12 MSs occur when an individual loses awareness and subsequently gains awareness after a brief lapse in consciousness, or when there are sudden shifts between states of wakefulness and sleep In behavioral terms, MSs manifest as droopy eyes, slow eyelid-closure, and head nodding2 In electrical terms, microsleeps are often classified as a shift in electroencephalography EEG during which 4–7 Hz theta wave activity replaces the waking 8–13 Hz alpha wave background rhythm3

MSs often occur as a result of sleep deprivation, though normal non-sleep deprived individuals can also experience MSs during monotonous tasks4 Some experts define microsleep according to behavioral criteria head nods, drooping eyelids, etc, while others rely on EEG markers5 Since there are many ways to detect MSs in a variety of contexts there is little agreement on how best to identify and classify microsleep episodes

Microsleeps become extremely dangerous when they occur in situations that demand constant alertness, such as driving a motor vehicle or working with heavy machinery People who experience microsleeps often remain unaware of them, instead believing themselves to have been awake the whole time, or to have temporarily lost focus6

Contents

  • 1 Background and significance
  • 2 Neural correlates
  • 3 Detection methods and classifications
  • 4 Diseases, clinical studies, and pharmacology
  • 5 In popular culture
  • 6 See also
  • 7 References
    • 71 Footnotes
    • 72 Works cites

Background and significanceedit

Eyelid closed, demonstrating microsleep event according to eye-video test Traffic collision, a possible consequence of microsleep

With over 1,550 fatalities and 40,000 nonfatal injuries occurring annually in the United States alone as a result of drowsy driving, sleep loss has become a public health problem78 When experiencing microsleeps while driving an automobile, from the perspective of the driver, he or she drives a car, and then suddenly realizes that several seconds have passed by unnoticed It is not obvious to the driver that he or she was asleep during those missing seconds, although this is in fact what happened The sleeping driver is at very high risk for having a collision during a microsleep episode9

Historically, many accidents and catastrophes have resulted from microsleep episodes in these circumstances10 For example, a microsleep episode is claimed to have been one factor contributing to the Waterfall train disaster in 2003; the driver had a heart attack and the guard who should have reacted to the train's increasing speed is said by his defender to have microslept, thus causing him to be held unaccountable On May 31, 2009, an Air France plane Air France Flight 447 carrying 228 people from Brazil to France crashed into the Atlantic Ocean, killing everyone on board The pilot of the plane reported "I didn't sleep enough last night One hour – it's not enough," handing over control to the two co-pilots who did not respond appropriately when the plane was in distress1112 Perhaps the most notable example was the Chernobyl nuclear reactor accident in the Ukraine in April, 1986 The reactor began to overheat at about 1:30am because critical cooling valves were shut off The shiftworkers, sleep-deprived and likely experiencing microsleeps with consequent reduced decision-making ability, mistakenly disabled the cooling system, causing the reactor to overheat As a result, there was a destructive explosion, resulting in numerous radiation-related injuries and casualties13

Thus, microsleeps are often examined in the context of driver drowsiness detection and prevention of work-related injuries and public safety incidents eg truck crashes, locomotive crashes, airplane crashes, etc Some statistics are below:

  • 44% of drivers during late-night driving become dangerously sleepy14
  • Extremely fatiguing work protocols increase accident probability from near 0% to 35%15
  • Chronic microsleeps MSs not only increase probability for injury but also decrease worker productivity and increase likelihood for absenteeism from work16
  • According to one Centers for Disease Control and Prevention CDC study, among 74,571 adult respondents in 12 US states, 353% reported <7 hours of sleep during a typical 24-hour period, 480% reported snoring, 379% reported unintentionally falling asleep during the day at least once in the preceding month, and 47% reported nodding off or falling asleep while driving at least once in the preceding month7
  • The National Highway Traffic Safety Administration estimates that 25% of fatal crashes and 2% of injury crashes involve drowsy driving17
  • Fatigue is associated with 250 fatalities in air carrier accidents in last 16 years18

However, most microsleeps are not dangerous Microsleeps can be induced from monotonous tasks such as staring at a wall or listening to a boring lecture In this context, these microsleeps are called daytime parahypnagogia DPH episodes, which can last for less than a second to a few seconds and often occur when the eyes are open19

Neural correlatesedit

Generally, microsleeps are characterized by a decrease in activity in wakefulness-related regions of the brain and an increase in activity in sleep-related regions of the brain Looking at neural correlates of microsleeps is difficult because microsleeps can also be triggered by monotonous tasks eg such as driving or dozing off in class Therefore, it is important to examine neural correlates of microsleep events with respect to experimental set-ups eg simulated driving set-up, reaction time set-up, etc Individual variability in brain structure also makes it difficult to diagnose microsleep events objectively

In one study neural activity underlying MSs was investigated by simultaneously measuring eye video, response behavior, EEG, and fMRI in normally-rested individuals engaged in a sensory-motor task2 Twenty participants tracked a visual stimulus with a joystick for 50 minutes in 2 dimensions up/down/right/left on a computer screen Participants performed this task in an fMRI scanner such that joystick response, right eye-video, EEG 60 EEG electrodes, and fMRI data were recorded simultaneously Most participants had frequent microsleeps >35 in a continuous visuomotor task tracking visual stimulus on a screen, corresponding with decreased activity in arousal-related brain regions over time thalamus, midbrain, and the posterior cingulate cortex2

Another study examined the activation patterns of 5 people who woke up from microsleeps in a simulated driving experiment4 It was found that upon awakening the visual area, frontal cortex, limbic lobe were activated in the intense activation phase and the frontal cortex, temporal cortex, primary motor area, and insula were activated in the post abrupt awakening phase Therefore, the study concluded that decision-making was not activated immediately upon waking up from a MS episode, likely increasing risk of injury in intense decision-making tasks like driving or surgery

The transition from wakefulness to sleep is regulated by a variety of chemicals Dopamine likely causes the 'feeling sleepy' side of microsleeps, while adenosine likely reduces microsleep events by promoting wakefulness It has been shown that microsleeps correlate with spontaneous pontine-geniculate-occipital PGO waves waves, which suppress visual processing in the basal ganglia When this pathway is not activated, cells in the superior colliculus which causes release of dopamine cannot be dis-inhibited via the basal ganglia, leading to poor processing ability and microsleep onset20

Detection methods and classificationsedit

There are currently many ways to detect microsleeps; however, there is a lack of general consensus as to the best way to identify and classify microsleeps The simplest methods to detect these events seem to be through psychological tests, speech tests, and behavioral tests eg yawn test and eye-video test More complex and expensive ways to detect microsleeps include EEG, fMRI, EOG, and PSG tied to various software platforms When multiple tests are used in parallel, detection of microsleeps most likely will become more accurate2

Method Description or examples
Polysomnography PSG PSG monitors many body functions including brain EEG, eye movements EOG, muscle activity or skeletal muscle activation EMG and heart rhythm ECG during sleep
Electroencephalography EEG EEG records the brain's spontaneous electrical activity over a short period of time, usually 20–40 minutes, as recorded from multiple electrodes on the scalp21 Microsleeps have EEG shift to slower frequencies from alpha to theta waves22
Functional magnetic resonance imaging fMRI A functional neuroimaging procedure using MRI technology that measures brain activity by detecting associated changes in blood flow detects what regions of brain are active during microsleep events23
Psychological tests Reaction time test, Karolinska Sleepiness Scale KSS,24 Maintenance of Wakefulness Test MWT,25 Multiple Sleep Latency Test MSLT26
Electrooculogram EOG EOG is a technique for measuring the resting potential of the retina in the human eye27
Eye-video test Measures eyes blinking and eye movements to detect microsleep events2829
Mouth yawning test Counts number of yawns over a period of time30
Speech tests Examines emotions and/or prosody in speech to predict microsleep episodes243132

Despite attempts to globally classify microsleeps through these detection methods with particular emphasis on EEG and slow eyelid closure tests, there is great variability in the types of microsleeps that people experience33 Subjective, self-reported psychological tests like the Karolinska Sleepiness Scale KSS, though widely adopted and positively correlated to EEG, often have limited utility because individuals sometimes are not aware of their level of sleepiness34 Future research needs to focus more on objective microstates eg detailed electrical output in briefer intervals that underlie microsleep events so that electrical events can be understood in terms of behavioral events with greater accuracy35 Then microsleep events could be more seamlessly distinguished from other states of consciousness, such as silent consciousness experienced during meditation36

Diseases, clinical studies, and pharmacologyedit

Microsleeps are often tied to diseases Sleep apnea is by far the most significant disease tied to microsleeps in terms of prevalence, affecting roughly 10–15 million people37 Other diseases that may be tied to microsleeps include narcolepsy, hypersomnia, schizophrenia, and other causes of excessive daytime sleepiness Microsleep episodes are often neglected and are not used as a diagnostic indicator for these diseases Instead, clinicians use instrumentation like PSG to do a sleep study on patients to assess overall sleep quality in a laboratory setting38

Microsleeps that recur and negatively influence day-to-day living often are clustered into the category of excessive daytime sleepiness Thus, most clinical studies related to microsleeps are in the context of reducing microsleeps in excessive daytime sleepiness through the use of pharmacological interventions Particularly, modafinil has become a popular drug to reduce microsleeps due to its stimulant effect with little to no side effects, and new drugs are often compared to the results of modafinil and placebo to assess efficacy eg methylphenidate in Parkinson's Disease Modafinil is also being tested across a range of diseases such as schizophrenia, narcolepsy, cataplexy, and sleep apnea Overall, the trajectory of clinical studies relating to negative symptom microsleeps seems to more thoroughly test modafinil across more diseases and compare new drugs to the efficacy of modafinil to reduce the negative effects of microsleeps on people across a spectrum of diseases

Title Interventions Conditions
Effects of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy39 Drug: BF2649, Drug: Modafinil, Drug: Placebo Treatment of Excessive Daytime Sleepiness in Narcolepsy
Efficacy and Safety Study of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy40 Drug: BF2649, Modafinil, Placebo Narcolepsy, Excessive Daytime Sleepiness, Cataplexy, Sleep Disorders
Dose Range Finding Study of BF2649 Versus Placebo to Treat Excessive Daytime Sleepiness in Parkinson's Disease Patients41 Drug: Placebo, Drug: BF 2649 5 mg, Drug: BF 2649 10 mg, Drug: BF 2649 20 mg, Drug: BF 2649 40 mg Excessive Daytime Sleepiness, Parkinson's Disease
A Study Of A Novel Compound For Excessive Daytime Sleepiness Associated With Narcolepsy42 Drug: Placebo, Drug: PF-03654746 Excessive Daytime Sleepiness, Narcolepsy
Treatment of Refractory Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome OSA/HS Using Nasal Continuous Positive Airway Pressure nCPAP Therapy 0249-01543 Comparator: MK0249, Drug: Comparator: placebo, Drug: Comparator: modafinil Sleep Apnea Obstructive, Hypopnea Syndrome, Excessive Daytime Sleepiness
Pitolisant to Assess Weekly Frequency of Cataplexy Attacks and EDS in Narcoleptic Patients HARMONY CTP44 Drug: Pitolisant, Drug: Placebo Narcolepsy with Cataplexy, Excessive Daytime Sleepiness
Comparison of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinson's Disease45 Drug: modafinil, Drug: methylphenidate Parkinson's Disease
Modafinil Augmentation Therapy for Excessive Daytime Sleepiness and Negative Symptoms in Patients With Schizophrenia46 Drug: Modafinil, Drug: Placebo Schizophrenia
Efficacy and Safety of BF2649 in Excessive Daytime Sleepiness EDS in Parkinson's Disease47 Drug: BF2649 Pitolisant Parkinson's Disease
Trial of Xyrem for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson's Disease PD48 Drug: sodium oxybate Parkinson's Disease

Microsleeps sometimes are a side effect of various drugs, particularly in reference to dopamine-stimulating drugs in Parkinson's Disease Particularly, somnolence is a recognized adverse effect of dopamine agonists, pramipexole and ropinirole These drugs are known to cause sudden-onset sleep spells in roughly 50% of patients with Parkinson's disease PD while they were driving49 Therefore, clinical interventions pertaining to microsleeps may also encompass reducing excessive sleepiness as a side effect of drug administration

Most microsleeps are not clinically significant, however Individuals who feel sleepy and wish to maintain alertness often consume over-the-counter stimulants such as caffeine in coffee More specifically, it has been shown that high-frequency low-dose caffeine intake is effective at countering poor work performance effects due to extended wakefulness, confirming the hypothesis that adenosine is a mediator of performance decrements associated with extended wakefulness50 Other stimulants that could decrease microsleep frequency include Adderall, amphetamine, cocaine, and tobacco5152

In popular cultureedit

Microsleep is featured extensively in the popular horror film franchise A Nightmare on Elm Street It is referred to as "micro naps" in the 2010 reboot specifically

In 30 Rock season 7 episode 5 'There's No I in America', Liz asks "How do you sleep at night, Jack", and Jack replies "I don't I take thousands of micro-naps during the day"

See alsoedit

  • Sleep debt
  • Vigilance
  • Drowsiness
  • Hypnic jerk

Referencesedit

Footnotesedit

  1. ^ International Classification of Sleep Disorders Diagnostic and Coding Manual, http://wwwesstorg/adds/ICSDpdf, page 343
  2. ^ a b c d e Poudel, G R, Innes, C R, Bones, P J, Watts, R, & Jones, R D 2012 Losing the struggle to stay awake: Divergent thalamic and cortical activity during microsleeps Human Brain Mapping: 00:000-000
  3. ^ Paul, Amit; Linda Ng Boyle; Jon Tippin; Matthew Rizzo 2005 "Variability of driving performance during microsleeps" PDF Proceedings of the Third International Driving Symposium on Human Factors in Driver Assessment, Training and Vehicle Design Retrieved 2008-02-10 
  4. ^ a b Chou, Y H, Chuang, C C, Zao, J K, Ko, L W, & Lin, C T 2011, August An fMRI study of abrupt-awake episodes during behavioral microsleeps In Engineering in Medicine and Biology Society, EMBC, 2011 Annual International Conference of the IEEE pp 5060-5063 IEEE
  5. ^ Poudel, GR; Innes, C R H; Bones, PJ; Watts, R; Jones, R D, "Losing the struggle to stay awake: divergent thalamic and cortical activity during microsleeps" PDF Human Brain Mapping doi:101002/hbm22178 Retrieved 2013-03-20 
  6. ^ Higgins, Laura; Fette Bernie "Drowsy Driving" PDF Retrieved 2013-06-12 
  7. ^ a b Insufficient Sleep Is a Public Health Epidemic http://wwwcdcgov/features/dssleep/
  8. ^ US Department of Transportation, National Highway Traffic Safety Administration, National Center on Sleep Disorders Research, National Heart Lung and Blood Institute Drowsy driving and automobile crashes National Highway Traffic Safety Administration Web Site Available at http://wwwnhtsagov/people/injury/drowsy_driving1/Drowsyhtml#NCSDR/NHTSAExternal Web Site Icon Accessed February 10, 2011
  9. ^ "Microsleep" sleepdexorg Retrieved 15 May 2015 
  10. ^ Blaivas AJ, Patel R, Hom D, Antigua K, Ashtyani H 2007 "Quantifying microsleep to help assess subjective sleepiness" Sleep Medicine Reviews 8 2: 156–9 doi:101016/jsleep200606011 PMID 17239659 
  11. ^ BEA final report, section 15, page 24 PDF page 26 of 224: "The crew had left Paris on Thursday 28 May 2009 in the morning and arrived in Rio de Janeiro in the evening of the same day"
  12. ^ "Revealed: Pilot of Air France jet that crashed in Atlantic Ocean killing 228 people had just ONE HOUR sleep before flight", The Daily Mail UK, 2013-03-15
  13. ^ Coren, Stanley Sleep Thieves: An Eye-Opening Exploration into the Science & Mysteries of Sleep New York: The Free Press, 1996 p x, 241–44
  14. ^ Åkerstedt, T, Hallvig, D, Anund, A, Fors, C, Schwarz, J, & Kecklund, G 2013 "Having to stop driving at night because of dangerous sleepiness–awareness, physiology and behaviour" Journal of Sleep Research
  15. ^ Sirois, B, Trutschel, U, Edwards, D, Sommer, D, & Golz, M 2010, January "Predicting Accident Probability from Frequency of Microsleep Events" In World Congress on Medical Physics and Biomedical Engineering, September 7–12, 2009, Munich, Germany pp 2284–2286 Springer Berlin Heidelberg
  16. ^ Swanson, L M, ARNEDT, J, Rosekind, M R, Belenky, G, Balkin, T J, & Drake, C 2011 "Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll" Journal of Sleep Research, 203, 487-494
  17. ^ National Highway Traffic Safety Administration Traffic Safety Facts Crash Stats: Drowsy Driving Washington, DC: DOT; 2011 DOT HS 811 4492011
  18. ^ "Pilot fatigue is like 'having too much to drink'" CNN, May 15, 2009 http://wwwcnncom/2009/TRAVEL/05/15/pilotfatiguebuffalocrash/
  19. ^ Gurstelle, E B, & De Oliveira, J L 2004 "Daytime parahypnagogia: a state of consciousness that occurs when we almost fall asleep" Medical Hypotheses, 622, 166–168
  20. ^ Silkis, I G 2010 Analysis of the effects of neuromodulators on the generation of spontaneous pontine-geniculate-occipital PGO waves Neurochemical Journal, 43, 170-177
  21. ^ Davidson, P R, Jones, R D, & Peiris, M T R 2006, January Detecting Behavioral Microsleeps using EEG and LSTM Recurrent Neural Networks InEngineering in Medicine and Biology Society, 2005 IEEE-EMBS 2005 27th Annual International Conference of the pp 5754-5757 IEEE
  22. ^ Boyle, L N, Tippin, J, Paul, A, & Rizzo, M 2008 Driver performance in the moments surrounding a microsleep Transportation research part F: traffic psychology and behaviour, 112, 126-136
  23. ^ Chou, Y H, Chuang, C C, Zao, J K, Ko, L W, & Lin, C T 2011, August An fMRI study of abrupt-awake episodes during behavioral microsleeps InEngineering in Medicine and Biology Society, EMBC, 2011 Annual International Conference of the IEEE pp 5060-5063 IEEE
  24. ^ a b Krajewski, J, Wieland, R, & Batliner, A 2008 An acoustic framework for detecting fatigue in speech based Human-Computer-Interaction In Computers Helping People with Special Needs pp 54-61 Springer Berlin Heidelberg
  25. ^ Gast, H, Schindler, K, Rummel, C, Herrmann, U S, Roth, C, Hess, C W, & Mathis, J 2011 EEG correlation and power during maintenance of wakefulness test after sleep-deprivation Clinical Neurophysiology, 12210, 2025-2031
  26. ^ Blaivas, A J, Patel, R, Hom, D, Antigua, K, & Ashtyani, H 2007 Quantifying microsleep to help assess subjective sleepiness Sleep Medicine Reviews,82, 156-159
  27. ^ Sommer, D, Chen, M, Golz, M, Trutschel, U, & Mandic, D 2005 Fusion of state space and frequency-domain features for improved microsleep detection In Artificial Neural Networks: Formal Models and Their Applications–ICANN 2005 pp 753-759 Springer Berlin Heidelberg
  28. ^ Poudel, G R, Innes, C R, Bones, P J, & Jones, R D 2010, August The relationship between behavioural microsleeps, visuomotor performance and EEG theta In Engineering in Medicine and Biology Society EMBC, 2010 Annual International Conference of the IEEE pp 4452-4455 IEEE
  29. ^ Malla, A M, Davidson, P R, Bones, P J, Green, R, & Jones, R D 2010, August Automated video-based measurement of eye closure for detecting behavioral microsleep In Engineering in Medicine and Biology Society EMBC, 2010 Annual International Conference of the IEEE pp 6741-6744 IEEE
  30. ^ Noor, H A M, & Ibrahim, R 2010 Fatigue detector using eyelid blinking and mouth yawning In Computer Vision and Graphics pp 134-141 Springer Berlin Heidelberg
  31. ^ Krajewski, J, Batliner, A, & Wieland, R 2008, December Multiple classifier applied on predicting microsleep from speech In Pattern Recognition, 2008 ICPR 2008 19th International Conference on pp 1-4 IEEE
  32. ^ Krajewski, J, Golz, M, Sommer, D, & Wieland, R 2009, January Genetic algorithm based feature selection applied on predicting microsleep from speech In 4th European Conference of the International Federation for Medical and Biological Engineering pp 184-187 Springer Berlin Heidelberg
  33. ^ Galley, N, Schleicher, R, & Galley, L 2003 Oculomotor Indicators of Driver Fatigue Driver Behaviour and Training: v III, 1, 97
  34. ^ Shahid, A, Wilkinson, K, & Marcu, S 2012 Karolinska Sleepiness Scale KSS In STOP, THAT and One Hundred Other Sleep Scales pp 209-210 Springer New York
  35. ^ Cvetkovic, D, & Cosic, I 2011 Sleep Onset Process as an Altered State of Consciousness In States of Consciousness pp 157-185 Springer Berlin Heidelberg
  36. ^ Baars, B J 2013 A scientific approach to silent consciousness Frontiers in psychology, 4
  37. ^ Kanagala, R, Murali, N S, Friedman, P A, Ammash, N M, Gersh, B J, Ballman, K V, & Somers, V K 2003 Obstructive sleep apnea and the recurrence of atrial fibrillation Circulation, 10720, 2589-2594
  38. ^ Tufik, S, Santos-Silva, R, Taddei, J A, & Bittencourt, L R A 2010 Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study Sleep Medicine Reviews, 115, 441-446
  39. ^ Effects of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy http://clinicaltrialsgov/ct2/show/record/NCT01638403
  40. ^ Efficacy and Safety Study of BF2649 in the Treatment of Excessive Daytime Sleepiness in Narcolepsy http://ClinicalTrialsgov/show/NCT01067222
  41. ^ Dose Range Finding Study of BF2649 Versus Placebo to Treat Excessive Daytime Sleepiness in Parkinson's Disease Patients http://ClinicalTrialsgov/show/NCT00642928
  42. ^ A Study Of A Novel Compound For Excessive Daytime Sleepiness Associated With Narcolepsy http://ClinicalTrialsgov/show/NCT01006122
  43. ^ Treatment of Refractory Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome OSA/HS Using Nasal Continuous Positive Airway Pressure nCPAP Therapy 0249-015 http://ClinicalTrialsgov/show/NCT00620659
  44. ^ Pitolisant to Assess Weekly Frequency of Cataplexy Attacks and EDS in Narcoleptic Patients HARMONY CTP http://ClinicalTrialsgov/show/NCT01800045
  45. ^ Comparison of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinson's Disease http://ClinicalTrialsgov/show/NCT00393562
  46. ^ Modafinil Augmentation Therapy for Excessive Daytime Sleepiness and Negative Symptoms in Patients With Schizophrenia http://ClinicalTrialsgov/show/NCT00546403
  47. ^ Efficacy and Safety of BF2649 in Excessive Daytime Sleepiness EDS in Parkinson's Disease http://ClinicalTrialsgov/show/NCT01066442
  48. ^ Trial of Xyrem for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson's Disease PD http://ClinicalTrialsgov/show/NCT00641186
  49. ^ Hobson, D E, Lang, A E, Martin, W W, Razmy, A, Rivest, J, & Fleming, J 2002 "Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease "JAMA: The Journal of the American Medical Association, 2874, 455–463 Chicago
  50. ^ Wyatt, J K, Cajochen, C, Cecco, A R D, Czeisler, C A, & Dijk, D J 2004 "Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness" SLEEP-NEW YORK THEN WESTCHESTER-, 273, 374–382
  51. ^ Jacobs, A 2005 "The Adderall advantage" New York Times, 31
  52. ^ Gawin, F H, & Ellinwood, E H 1988 "Cocaine and other stimulants: actions, abuse, and treatment" The New England Journal of Medicine

Works citesedit

  • Ogilvie RD June 2001 "The process of falling asleep" Sleep Med Rev 5 3: 247–270 doi:101053/smrv20010145 PMID 12530990 
  • Tirunahari VL, Zaidi SA, Sharma R, Skurnick J, Ashtyani H January 2003 "Microsleep and sleepiness: a comparison of multiple sleep latency test and scoring of microsleep as a diagnostic test for excessive daytime sleepiness" Sleep Med Rev 4 1: 63–7 doi:101016/s1389-94570200250-2 PMID 14592362 
  • Faber J, Novák M, Svoboda P, Tatarinov V, Tichý T 2003 "Microsleep from the electro- and psychophysiological point of view" Sb Lek in Czech 104 4: 375–85 PMID 15320529 

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Microsleep


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    29.10.2014


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